Ileostomies, colostomies, and urostomies are surgically created openings in which a portion of the intestine is brought through the abdominal wall to form a stoma, which may be permanent or temporary depending on the reason for surgery, i.e. disease, injury, birth defects or cancer. A pouching system or ‘appliance,’ as it is sometimes referred to, is used to collect waste material. Pouch styles and sizes vary from manufacturer to manufacturer, however, two main types of pouching systems are available: one-piece pouches with a built in skin barrier (faceplate), and two piece systems comprised of a faceplate and detachable pouch.
The two-part system provides a flange in the form of a pair of annular or ring-like rigid plastic parts designed to aid in either securing the pouch to the faceplate or removing the pouch at the user's discretion. Faceplates are further comprised of an adhesive layer formed of a soft, skin-friendly hydrocolloid containing adhesive material and provide therein a centrally located aperture to receive a stoma. Systems may further provide a peel and stick tape on the outer edges of a faceplate for additional adhesion. These faceplates are attached to the peristomal region of the user to protect the skin from irritating digestive juices. A convex faceplate is generally used when a stoma protrudes less than an inch and a flat faceplate is generally used when a stoma protrudes more than an inch.
Preoperative preparation for a stoma creation includes selection of the most optimal site and consideration is taken not only for skin creases, prior scars, and any bony prominences, but is also based on whether a patient has a flat, muscular abdomen, or an obese abdomen to allow for proper visualization and care. One problem, despite careful planning and individualized considerations, is that pressure from a waistband of jeans or clothing contacting or lying across any part of a faceplate can interfere with the quality of the seal and adherence to the skin of the user threatening a resulting loss of containment. Many other factors influence how long a pouching system will stay sealed. Subsequent leakage of waste can and does occur, often without warning, soiling clothes, causing unpleasant odors and embarrassment to the wearer.
Another problem faced by ostomates are parastomal hernias. Online research indicates that hernia is essentially caused by expansion of the stoma trephine aperture in the abdominal wall resulting from tangential pressure on the circumference of the opening, often gradually through the passage of time. Ideally, the stoma is brought through the rectus abdominus muscle (six pack muscle) that lies vertically adjacent one's belly button to reduce the likelihood of a hernia or stomal prolapse but bringing the stoma to the surface of the abdomen immediately creates a weakness and a potential for hernia. Coughing, sneezing, infection from surgery, obesity, weak muscles and the strain upon rising or sitting can cause a bulging at the stoma site with the potential for the muscle or skin of the abdomen to come away from the stoma creating a passageway for the viscera to protrude.
The size of the hernia generally increases with time, is often uncomfortable and is an embarrassment as its increased size can be seen under clothing and furthermore, it becomes difficult to attach a pouching system properly thereby causing peristomal skin breakdown. A trapped or twisted portion of intestine within the hernia may become obstructed or strangulated and may require emergency surgery to repair. Complicating matters are those who may be elderly, frail, or those for whom an anesthetic would be dangerous because of breathing or heart problems, are at great risk to undergo surgery for repair of the hernia. If the hernia is not causing any symptoms, a wide, firm hernia belt is suggested management. Although these factors are not a comprehensive list of complications, several online medical reports maintain that development of parastomal hernias are nearly an inevitable complication following formation of a stoma.
If hernia symptoms are severe, or to improve quality of life for an ostomate, methods of hernia repair may include resiting the stoma to a new location, which is a major operation to take down and transfer the stoma from one side to the other. Hernia repair without resiting the stoma may involve opening the adjacent abdominal wall to re-suture muscle and supporting tissues in the area either thru laparotomy or laparascopically. The use of mesh over and beyond the weakened area has been an alternative approach as well as prosthetic devices to keep the mesh from enlarging are used as adjunct to local repair of paracolostomy hernia.
Psychological struggles are another problem faced by ostomates. Although creation of a stoma is often a life-saving operation, many ostomates fear that others may notice the pouching system or a growing hernia under their clothing, or that a leak in public will cause embarrassment and humiliation resulting in isolation.